Workers comp provides benefits for employees who are injured at work. To receive benefits, you must file a claim. Unfortunately, not every claim is approved.
If your claim is not approved, you may request a workers comp hearing. During the hearing, the judge will review your case and determine if you are eligible for benefits. They will make a final determination on your claim.
A workers comp hearing should not be taken lightly. There’s a lot of the line. A favorable rule means you get your benefits. If the judge rules against you, you will be accountable for your medical expenses and wage losses.
With so much riding on your hearing, you must be prepared. This article will tell you what to expect when you have your day in court.
Before the Workers Comp Hearing
There are several preparatory steps you can take before the hearing. These include:
- Review Your Documents: Review the documents related to your claim including your medical records, reports, and claims administrator correspondence. All documents should be submitted to the court. You should have copies too.
- Understand the Roles: The claims administrator reviews and processes workers comp claims. They will be present at the hearing. They will submit evidence to support their position. They will also cross-examine witnesses. You may also hire an attorney (AKA the applicant’s attorney). They will present evidence and cross-examine witnesses.
- Medical Evaluation: You may have to undergo a medical evaluation before the hearing. The medical report may be used in your testimony.
- Depositions and Witness Statements: Sometimes depositions and witness statements are given before the workers’ comp hearing. The attorney will ask witnesses questions under oath. The responses will be recorded by a court reporter. The recordings will be used as evidence during the trial.
During the Workers Comp Hearing
Here’s what you can expect during the hearing process.
- Judge Review: The workers comp hearing will start with the judge’s review of preliminary matters. They will also explain the hearing procedures. Then the parties will make opening statements.
- Understanding the Roles: The judge will preside over the case. They will ask questions, rule on objections, and make the final decision. The applicant (you) will present your case including medical records, witnesses, testimonies, etc. The applicant’s attorney can also cross-examine witnesses. The claims administrator can also present evidence and cross-examine witnesses.
- Presenting Evidence: All parties can submit evidence to support their claims. The judge will review the evidence and use it to base their decision.
- Witness Testimony: Witnesses will be called to the stand to present evidence, testify, and share their knowledge of the incident.
- Cross-examination: All parties can cross-examine witnesses. They can ask witnesses additional questions after their initial testimony.
What Questions Will I Be Asked at the Workers Comp Hearing?
You will be asked several questions about your injury and treatment during the workers comp hearing. These include:
- Questions About the Incident: You will be asked how the injury happened, who was involved, what safety rules applied to the accident, and whether these safety rules were followed.
- Questions About Your Injury: The court will want to know the extent of your injury, your pain levels, your diagnoses, your estimated recovery time, and how your injury affects your ability to complete daily and work-related tasks. You must also provide details about your medical history and pre-existing conditions. It’s essential to tell the truth about your injuries. If you downplay them or lie about them, it can lead to a judgment against you.
- Questions About Your Treatment: These questions center around the type of treatment you are receiving, have received, and will receive, alternate, less expensive treatments available, the cost of the treatments, and any medical devices you may require.
- Questions About Your Conduct Since the Injury: The court will want to know how the injury affected your life. They will ask you if you followed your doctor’s treatment recommendations. They will also ask you if you have engaged in an activity that would make the injury worse.
After the Workers Comp Hearing
A decision is not typically handed down during a workers comp hearing. Parties must wait for the decision. They can also file an appeal if they feel the decision is unfair.
- Waiting for the Decision: A decision will be mailed to the parties within 30 days.
- Appealing the Decision: If you feel the decision is unfair, you have the right to appeal it. Appeals must be filed within 20 days after receiving the decision. If your petition for an appeal is denied, you can file an appeal with the Workers’ Compensation Appeals Board.
- Receiving Benefits: If the judge rules in your favor, you should receive benefits within 14 days of receiving the decision. The benefits may cover your medical expenses, lost wages, and disability. If the claims administrator does not comply and refuses to pay the benefits, you can file a petition for penalty or enforcement with the Workers Compensation Appeals Board.
- Medical Treatment: If you require ongoing medical treatment for your injury, you must continue seeing a doctor to receive benefits. You may also undergo regular medical evaluations to redetermine your eligibility.
A workers comp hearing is necessary for people who feel their claims have been unfairly denied. The steps in this article will get you prepared for the hearing so you have the best possible outcome. Good luck winning your case!